Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents

Abstract

In two German child and adolescent psychiatric treatment and research centers, a controlled treatment study was conducted in which two randomized treatment groups (in-patient treatment and home treatment) were compared. Subjects were children and adolescents with severe psychiatric disorders, for whom normal outpatient treatment was not sufficient (mean age of the patients was 11 years and 9 months at the beginning of treatment). The results showed no differences in therapy outcome between the two treatment modalities. In a further study, the results of which are presented here, a follow-up assessment (average follow-up interval: 3 years and 8 months) of the two treatment groups (follow-up sample of the inpatient treatment group: n = 33; home treatment group: n = 35) was undertaken in order to investigate the course of the psychiatric disturbances and the long-term effects of the treatments. As measurement categories for the outcome "adaption at school" and "number of marked symptoms" were used in pre-, post- and follow-up assessment. The most important results are 1) The number of marked psychiatric symptoms and the adaptation at school or work exhibit the same type of course over time. Post-treatment scores are much better when compared to pre-treatment scores, but decline slightly upon follow-up, although they remain significantly better than the pre-treatment scores. Thus, the study shows that improvements relating to the psychiatric symptoms are quite stable after several years. 2) There were no relevant differences between the treatment modalities "inpatient treatment" and "home treatment" in terms of effect-size upon follow-up, and in inferential analysis. Any tendency towards difference was in favor of home treatment. So the results give strong support to the conclusion that at least for a specific group of patients (about 15% of those patients usually treated in an inpatient setting) residential treatment can be replaced by home treatment and that the long-term therapeutic outcome of home treatment is stable and persistent. Thus, in terms of psychiatric care and clinical practice, our results provide empirical support to the idea that home treatment should be used more frequently and much more broadly in the future.

Review: Alternatives to inpatient care for children and adolescents with mental health disorders

“…A variety of interventions were investigated as alternatives to inpatient treatment, including multisystemic therapy (MST; Henggeler et al., ), day patient treatment (Herpertz‐Dahlmann et al., ), specialist outpatient service (Gowers et al., ), intensive home treatment (Mattejat, Hirt, Wilken, Schmidt, & Remschmidt, ; Winsberg, Bialer, Kupietz, Botti, & Balka, ) and supported discharge service (SDS; Boege, Corpus, Schepker, Kilian, & Fegert, ) versus inpatient treatment. A total of 569 participants were randomized across the studies.…”

“…A total of 569 participants were randomized across the studies. Allocation concealment was adequate in three studies (Boege et al., ; Gowers et al., ; Herpertz‐Dahlmann et al., ) and unclear in three studies (Henggeler et al., ; Mattejat et al., ; Winsberg et al., ). The Jadad score was two for three studies (Henggeler et al., ; Mattejat et al., ; Winsberg et al., ) and it was three for three studies (Boege et al., ; Gowers et al., ; Herpertz‐Dahlmann et al., ).…”

Systematic review of international evidence on the effectiveness and costs of paediatric home care for children and young people who are ill

“…1998); home‐based treatment for chronic or long‐term conditions (one RCT: Simell et al . 1995); home‐based treatment for mental health problems (two RCTs: Mattejat et al . 2001; Glueckauf et al .…”

Tier 4 Child and Adolescent Mental Health Services (CAMHS) ‐ Inpatient Care, Day Services and Alternatives: An Overview of Tier 4 CAMHS Provision in the UK

“…The key features are 24 hour a day, 7 days a week availability, rapid response time, and the ability to work flexibly with young people, their families and carers and a range of multi agency services. High quality evidence from Germany shows that certain groups of young people with mental disorders can be maintained as safely and successfully at home as in an inpatient unit, although only about 15% of potential inpatients were suitable to be managed in this way (Lay et al, 2001; Mattajat et al., 2001). The German studies and a randomised controlled trial of the similar Family Preservation Program in the US (Wilmshurst, 2002) also suggest that home based treatment leads to longer maintenance of symptom and behaviour improvements.…”